Intro To RadTech: Status of health care delivery

Question 1

What does HMO stand for?

Answer 1

Health maintenance organization

Question 2

What is capitation?

Answer 2

• prepayment for services on a per-member per-month basis
• physician or group receives specific amount regardless of how much care the patient needs
• the effect: less exams, procedures, tests ordered - less cost to the insurance company

Question 3

What is fee-for-service?

Answer 3

• method in which health care providers receive a fee for services performed
• individual fees…not “bundled” (as opposed to prepaid services)
• the holder makes all health care decisions independently
• patient (or insurance company) pays physician directly
• results in more tests and procedures ordered

Question 4

What is Managed Care?

Answer 4

• any arrangement for health care where there is an intermediate between the person seeking care and the physician
• who is the “manager”?- the insurance company

Characteristics:
Variety of techniques designed to reduce “unnecessary costs” through
• economic incentives to physicians
• review of medical necessity of services
• controls on inpatient admissions/length of stay
• selective contracting with H.C. Providers
• intensive management of high-cost care cases

Question 5

What is a PPO?

Answer 5

Preferred Provider Organization

• Patients choose from a finite list of doctors who have agreed to limit their fees(Co-pays apply’ deductible can apply)

I patients can go “out of network” for a higher out-of-pocket fee

Question 6

What is DRG?

Answer 6

Diagnosis-related groups

• 1983- federal government changed reimbursement for Medicare and Medicaid patients

• 467 categories of admitting diagnosis

Is there a conflict of interest in using DRG’s?

Cost-Containment measures. What effect on quality of care?
•ratio part-time vs. full-time personnel changes
•healthcare workers may need to have more than one place of employment
•reduction in number of people having “benefited” positions
•short-staffing
•burnout

Effect when shortage of qualified radiologic technologists
• work load increased
• stress increased
•use of “travelers”
•wage increased
•use of incentives- sign on bonus, e.g…

Question 7

What does ICG stand for?

Answer 7

International Classification of Diseases

Question 8

What is RIS?

Answer 8

Radiology Information System

Question 9

What is the CMA?

Answer 9

California Medical Association